The Upstreamist Doctor

Rishi Manchanda is a healthcare not sickcare visionary.

He founded HealthBegins, a group to train doctors to become proverbial upstreamists–a term he describes in his TED talk and book, The Upstream Doctors.

The upstream proverb: Imagine a river, heading towards rapids, towards a deadly waterfall. In the water are children. At risk of death. Three friends leap to action. One mans the waterfall, “I’m going to save those most at risk to drown!” risking her own life to save the children one by one just before they fall to their death. A second organizes and mans a raft system before the rapids begin, saying “I’m going to get as many children as possible out of the water!” saving 20 lives each time he rafts across the river. The third friend starts swimming upstream.

“Where are you going?” the two friends ask. “Come help us save lives!”

“I’m going to find out who or what is throwing these children in the water, and stop it!” And away the upstreamist friend swims to find out and address the underlying source of the problem.

Who is the doctor upstreamist?
Not the specialists, trauma surgeons, or ER docs that keep people from dying just before they’re pulled into the Waterfall Styx.
Not the primary care doctors who man the rafts to pull people out of the river before they hit the rapids.
The healthcare upstreamists are the workers who say–why are all these people sick in the first place, and what is happening upstream that we can change to keep them from falling into ill health, and prevent them from dying?

We don’t have enough upstreamists in our healthcare system. We need one upstreamist for every 20-30 clinicians, Dr. Manchanda says. Someone to implement processes to address underlying problems. People who ask: What is the problem? What is the root cause? How do we address it? And put the processes into play within the healthcare system.

There are a few thousand upstreamist doctors practicing in the United States today, he says. We will need 25,000 by 2020 to keep Americans healthy.

And so we begin by training future health care providers to recognize health where it begins: outside of the hospital, inside of the homes, schools, workplaces, restaurants, grocery stores, parks and playgrounds where we live, work, sleep, eat and play.

Zipcodes, not DNA codes, the greater determinants of our health.

Addressing health, where it begins. HealthBegins.

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